Rupture of the Distal Biceps Tendon in a Collegiate Football Player: a Case Report

Objective: To provide health care personnel with guidelines for the management of a distal biceps tendon rupture.

Background: Traumatic ruptures of the biceps tendon are rare, but serious, and usually involve the long head of the proximal insertion. Ruptures of the distal tendon account for only 3% of all biceps tendon ruptures. A history of tendinitis, overuse, or anabolic steroid abuse may predispose tendons to rupture. Surgical repair, followed by a comprehensive rehabilitation program, is indicated to regain full strength and range of motion in both flexion and supination.

Differential Diagnosis: Rupture of the distal head of the biceps brachii muscle at the insertion on the radial tuberosity.

Treatment: After the injury, the athlete continued to compete for the remainder of the collegiate football season. He then underwent surgery to repair the tendon at its insertion. Post- operatively, the athlete was immobilized in a cast and then a brace to prevent any movement of the muscle. Rehabilitation proceeded with isometric exercises and manual resistive exercises of the shoulder and wrist. At 16 weeks, the athlete was cleared for biceps curls and wrist supination. At 6 months, the athlete had regained full use of the muscle.

Uniqueness: This is a relatively rare injury, usually occurring at the proximal tendon insertion and in those who are middle aged (30 to 50 years old). Also, the surgical intervention in this case was delayed without detrimental effects to the patient.

Conclusions: This study shows that, while surgical intervention to repair a ruptured distal biceps tendon is necessary, appropriate conservative measures can be taken to allow surgery to be delayed without harm to the patient. The athletic trainer should be aware of how to recognize and treat this injury.